FISCAL YEAR 2016-17 3 RD QUARTER UPDATE AND DRAFT BUDGET FY 2017-18 - - PowerPoint PPT Presentation

FISCAL YEAR 2016-17 3RD QUARTER UPDATE AND DRAFT BUDGET FY 2017-18

mmUnityCare

GENDA

Fiscal

Year 2016-17 Update

Information that informs the budgeting process Fiscal

Year 2017-18 Budget Information

JUNE 2017 – 9TH MONTH OF THE FISCAL YEAR

Encounters were 5.5% under budget for the month and 2.9% greater than June

2016.

Medical encounters were under budget by 1,761 (7%) for the month and 7,629

year to date (3.5%).

Year to date, total encounters are 6,838 or 2.6% under budget, and 13,103 o

5.4% greater than prior year.

ENCOUNTERS

FY 2015-16 Budget FY 2016-17 Behavioral Health 12,042 10,738 12,849 Dental 35,123 36,839 35,519 Medical 197,650 217,179 209,550

• 50,000

100,000 150,000 200,000 250,000 300,000

Encounter Comparison FY 16 - 244,815 Budget - 264,756 FY 17 – 257,918

JUNE 2017 – 9TH MONTH OF THE FISCAL YEAR

June revenue was $36,900 under budget, and year to date is $5.8 million

under budget, encounters are under budget.

June expenses were under budget by $281, 000 and year to date expenses ar

almost $7 million under budget as well.

June operations reflected an excess of $454,000 and year to date the excess

$1.3 million.

Actual 2016-17 as of June 30, 2017 Budget 2016-17

Encounters 257,918 264,759 T

• tal Patient Service Revenue

27,978,908 29,916,152 T

• tal Grant Revenue

7,584,408 6,374,998 Other Revenue CCC Primary Care Agreement 26,072,693 29,024,163 Other 225,000 DSRIP Revenue 9,963,451 11,917,308 DSRIP Revenue ATCIC 312,489 239,553 T

• tal Other Revenue

36,348,633 41,406,024 T

• tal Revenue

71,911,949 77,697,174 Expenditures Salaries and Wages 35,840,227 39,232,450 Contract Labor 4,846,086 5,322,986 Employee Benefits 9,274,758 10,394,126 Supplies 5,137,825 6,688,325 Professional Fees 295,179 207,798 Contracted Services 9,811,069 9,567,191 Insurance 140,826 124,339 Occupancy 3,431,738 3,204,602 Equipment 389,950 475,369 Bad Debt 1,441,949 2,389,108 Other Exp 466

• T
• tal Expenditures

70,610,073 77,606,294

Excess (Deficit) From Operations

1,301,876 90,880

JUNE 2017 – 9TH MONTH OF THE FISCAL YEAR

Gross cost per encounter is $273.77 compared to the annual budget of

$294.29 and the prior year of $286.44.

Gross cost is ALL costs, medical, behavioral, dental, IT, maintenance, billing – a

• verhead, everything.

Gross cost per encounter is all costs divided by all encounters (medical,

dental , behavioral, everything).

SOME ITEMS THAT CONTRIBUTE TO A HIGHER COST PER ENCOUNTER THAN OTHER COMMUNITY CLINICS

David Powell (HIV/Aids) and ARCH (Homeless) Health Centers contributes $18 of

the cost per encounter. Each of these clinics has much higher cost per encounter compared to the rest of our clinics given the special populations served.

Pharmacy benefits – CommUnityCare has historically provided pharmacy benefits to

sliding fee scale (SFS) patients for a modest co-payment. Pharmacy contributes $15 to cost per encounter with $13 of this $15 for the cost of buying medications.

JUNE 2017 – PROVIDER VACANCIES

7 8 8 14 13 11 11 10 10 9 1 3 4 4 4 4 4 5 7 11

Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Provider Vacancy Trend Report FY17 to Date

True Vacancies Signed Offers

True Vacancy: A position that is not currentl an employed CUC provider. The vacancy ma not be covered by a locum or PRN provi regular and/or interim basis. Signed Offers: When a signed offer letter received by a provider candidate, but they hav started employment with CUC. Variances fro to month can include providers who sta employment (reduction), newly signed offer (addition), carry over from the previous mo change), and/or a combination thereof.

DSRIP UPDATE

DSRIP – CATEGORY 1 AND 2: VOLUME RELATED

Data represents effort through June 2017

• 75% of the DSRIP year

complete.

GI/Hepatitis C – Initiative to maximize use of Advance Practice Professionals to support this work.

DSRIP Category I and II Projects DY6 Target June 2016 % o Disease Management Registry 7,192 7,027 Primary care Medical Home 53,153 48,960 Chronic Disease Management 7,192 7,027 Expanded Primary Care 226,610 186,320 Dental Expansion: All Patient Types 43,000 33,015 Dental Expansion: Pregnant Women 763 696 Dental Expansion: Patients with I Diagnosis 6,109 7,032 Dental Expansion: Patients with I Diagnosis + Pregnant 6,599 7,539 Telepsychiatry: Encounters 2,700 2,399 Pulmonology 3,827 2,847 Gastroenterology Clinic 4,343 3,100 Mobile Health Teams: Encounters 4,000 3,201 Centering Pregnancy 164 143 Integrated Behavioral Health: Enrollment into Disease Registry 400 1,277 Integrated Behavioral Health: Providing Care according to Established IBH Care Protocols 400 1,479

DSRIP – CATEGORY 3 UALITY

epresents effort through June 2017 75% of the DSRIP year complete

• d Pressure (BP) control and LDL

emain below target. We have igned and implemented multiple ative to address these and mprovement is beginning. We expect meet target for BP control by year .

DSRIP Category III DY6 Target June 2017 Difference % o Comprehensive Diabetes LDL Screenings (18-64 yoa) 83.56% 76.50% 7.06% Diabetes Care: Foot Exam (18-64 yoa) 77.38% 87.20%

• 9.82%

Diabetes Care: Nephropathy (18-64 yoa) 87.85% 89.86%

• 2.01%

Tobacco Use Screenings and Cessation (18 yoa plus) 80.94% 99.57%

• 18.63%

High Blood Pressure Screening (18 yoa plus) 50.09% 58.21%

• 8.12%

Adult BMI Assessment and Follow-Up (18-64 yoa) 71.33% 98.45%

• 27.12%

Controlling High Blood Pressure for Diabetics (18-64 yoa) 71.28% 70.90% 0.38% Controlling High Blood Pressure for Dental Patients (18-64 yoa) 64.41% 67.34%

• 2.93%

Hepatitis C Cure Rate (18-64 yoa) 30.23% 95.18%

• 64.95%

Asthma Percent Opportunity Achieved (all ages) 26.67% 35.29%

• 8.62%

Improvement of PHQ-9 (all ages) 13.28 10.42 Annual Monitoring for Patients on Diuretics (18 yoa plus) 86.09% 90.53%

• 4.44%

Annual Monitoring for Patients on ACE / ARBs (18 yoa plus) 85.72% 90.88%

• 5.16%

Diabetes Care: Retinal Eye Exam (18-64 yoa) 48.73% 61.26%

• 12.53%

DRAFT BUDGET FY 2017-18

BUDGETARY PRESSURES – COMMUNITY HEALTH CENTER FISCAL CLIFF

CHC FISCAL CLIFF – IMPACT ON CUC IF CONGRESS DOESN’T ACT

THER INFORMATION INFORMING THE BUDGETING PROCESS

¡ The number of clinics will not change during the year. RBJ Dental will clos

at the end of August 2017 due to construction noting that staff and the services are being relocated to one of our other 4 dental locations. We al anticipate establishing primary care medical services within the Del Valle community.

¡ Encounters –developed with the Chief Medical Officer, targets for each type

• f provider.

REVENUE

Patient Service Revenue is estimated by type of payor; Medicare, Medicaid, CHIP

, Commercial Insurance, State Family Planning, Pharmacy Network.

¡ MAP and Sliding Fee Scale (SFS) in this category consists of the patient co-payment

portion, amounts due from the CCC are in Other Revenue.

Grant Revenue-estimated based on current approved grants. Most grant periods ar

not aligned with the fiscal year, information is estimated based on known amounts.

REVENUE

Other Revenue ¡ CCC investment – Still under construction. This will be a multiple payment simil

to the prior year.

¡ Potentially multiple payment parts- ¡ Medical, Dental, Specialty, and Behavioral Health payment per encounter for

MAP and Sliding Fee Scale with carve outs for DSRIP projects and David Powel

¡ Community Benefit to support Pharmacy, David Powell and family planning

services.

¡ Payment for “non encounter” services such as care management, nurse visits,

clinical pharmacists and nutritionist.

¡ Payment for achievement of access and quality measures.

REVENUE

¡ DSRIP – Delivery System Reform Incentive Payment – Budgets have not been

prepared, this is an estimate.

EXPENSES

Salaries, Contract Labor, Employee Benefits ¡ Salaries are increased by 3% for merit and additional $500,000 for market

• adjustments. Staff is added for selected areas, mostly care management, this is sti

in review.

¡ Contract Labor – primarily provider cost to operate Hancock, Blackstock,

Gastroenterology, Pulmonary, OB/Gyn, and internal medicine at Southeast.

¡ Employee Benefits – determined by the number of employees and the contracted

benefit cost.

Supplies – the category was increased 3% and $200,000 added for computer refres

EXPENSES

Professional fees – This category is largely physician recruitment fees, includes some

accounting and legal fees.

Contracted Services – There are many items in this category, the largest is

Information Technology . Other items are behavioral health, billing & collection services, lab services, translation services, payroll services and maintenance. The category was increased 3%, lab was increased an additional $500,000, Information Technology received an additional base increase of $228,000 plus $140,000 for the communication system.

Insurance – This is mostly property and general liability, insurance is jointly with

Central Health. CommUnityCare receives professional liability coverage through the Federal Tort Claims Act (FTCA) because of FQHC status.

EXPENSES

Occupancy – This is rent, utilities, janitorial, security. The category was increased 3%

plus an increase of $234,000 for rent at the Atrium previously assumed by the Community Care Collaborative (CCC).

Equipment – This is mainly depreciation and copier or other equipment rental. It w

increased 3%.

Bad Debt – This was assumed to be similar to FY17.

Budget 2016-17 Actual 2016-7 Projected Draft Budget 2017-18 V I Encounters 352,546 341,639 344,732 T

• tal Patient Service Revenue

39,841,775 36,816,447 37,215,588 T

• tal Grant Revenue

8,500,000 9,894,408 9,812,484 Other Revenue CCC Primary Care Agreement 38,698,883 35,938,053 39,457,456 Other 300000 DSRIP Revenue 16,089,740 13,899,307 13,906,473 DSRIP Revenue ATCIC 319,402 312,489 222,722 T

• tal Other Revenue

55,408,025 50,149,849 53,586,651 T

• tal Revenue

103,749,800 96,860,704 100,614,723 Expenditures Salaries and Wages 52,453,647 48,393,625 51,186,510 Contract Labor 7,097,315 6,542,904 6,613,342 Employee Benefits 13,896,756 12,714,753 13,308,492 Supplies 8,915,479 7,056,390 6,949,083 Professional Fees 277,059 326,346 431,426 Contracted Services 12,756,252 13,659,338 14,328,756 Insurance 165,785 189,517 195,198 Occupancy 4,272,803 4,242,528 4,895,055 Equipment 633,825 503,401 538,044 Bad Debt 3,280,879 2,200,949 2,167,970 Other Exp

• 466

847 T

• tal Expenditures

103,749,800 95,830,217 100,614,723 Excess (Deficit) from Operations

• 1,030,487

(0)

BUDGET SUMMARY

This draft of the FY 2017-18 budget has major items to resolve- ¡ CCC Primary Care Agreement – continue to work with the CCC on the

individual areas. The amount will likely change as some services move from DSRIP to the Primary Care Agreement.

¡ DSRIP- This is only an estimate based on the current year. Some projects will

change, affecting this category as well as the CCC Primary Care Agreement.

¡ Staffing requests are being reviewed.

BUDGET SUMMARY

ext steps-

¡ Continue work on the CCC agreements and revise the budget. The next revisio

will be reviewed with the CommUnityCare board August 22.

¡ Finalize budget revisions in September and present the final budget version at the

September 26 CommUnityCare board meeting.

QUESTIONS?